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As research continues to document differences in the prevalence of mental health problems such as depression across racial/ethnic groups, the issue of measurement equivalence becomes increasingly important to address. The Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescent depression. This study applied a differential item functioning (DIF) framework to data from a sample of 6th and 8th grade students in the Seattle Public School District (N = 3,593) to investigate the measurement equivalence of the MFQ. Several items in the MFQ were found to have DIF, but this DIF was associated with negligible individual- or group-level impact. These results suggest that differences in MFQ scores across groups are unlikely to be caused by measurement non-equivalence.

Depression during adolescence represents a significant public health concern. It is estimated that up to 20% of adolescents experience an episode of depression that interferes with academic and social functioning and is associated with an increased risk for self-harm. Although significant progress has been made in the last decade in treating mental health problems in young people, effective treatment of depression has been harder to demonstrate. In this paper, we describe the application of a promising evidence-based treatment for adult depression, behavioral activation (BA), to the treatment of depressed adolescents. We briefly present the history and overview of the standard BA approach to adult depression and discuss the rationale for the extension of this approach to adolescent depression. We then focus in detail on the process of adapting the treatment to be adolescent-specific by presenting an early client whom we treated without success. The paper closes with a discussion of lessons learned from our experience of treatment failure, including the need to (a) take a more nuanced view of rumination with a focus on shaping brooding into reflective problem solving, (b) maintain a structured but flexible approach that allows for early introduction of treatment skills most relevant to the individual adolescent, (c) build in careful tracking of suicide risk, and (d) attend to family engagement. Implications for future research and clinical practice also are addressed.

This article describes the training and consultation procedures implemented to adapt and pilot modular psychotherapy for use by therapists treating youth with depression and anxiety in school-based health centers (SBHCs). Module selection and adaptation decisions were data driven and intended to increase compatibility with the school context. Seven SBHC therapists in the district participated in the yearlong training and consultation program. Findings indicated that participating therapists were able to successfully select appropriate students for treatment, systematically track their use of treatment modules, and administer standardized measures to monitor symptom change in 94% of their sessions. In the context of these findings, we discuss practitioner engagement barriers and solutions, school-based therapist use of standardized assessment tools, and the utility of a brief SBHC intervention model. (Contains 3 tables and 1 figure.)

This study examined whether improvement in parents' depression was linked with changes in their children's depressive symptoms and functioning. Participants were 223 parents and children ranging in age from 7 to 17 years old (M = 12.13, SD = 2.31); 126 parents were in treatment for depression and 97 parents were nondepressed. Children were evaluated 6 times over 2 years. Changes in parents' depressive symptoms predicted changes in children's depressive symptoms over and above the effect of time; children's symptoms significantly predicted parents' symptoms. Trajectories of children's depressive symptoms differed significantly for children of remitted versus nonremitted depressed parents, and these differences were significantly predicted by their parents' level of depression. The relation between parents' and children's depressive symptoms was partially mediated by parental acceptance. (Contains 5 tables and 4 figures.)

The prevalence and persistence of thoughts of death and suicide during early adolescence were estimated in a community-based cohort. A latent class approach was used to identify distinct subgroups based on endorsements to depression items administered repeatedly over 24 months. Two classes emerged, with 75% in a low ideation class across four assessments. Less than 2% persisted in the high ideation class over three or more assessments. African American and Asian American adolescents were more likely than European Americans to belong to the high ideation class. No members of the low ideation class endorsed "thought about killing myself," while "thoughts of death and dying" was endorsed by members of both classes. Implications for interpreting meanings of death and suicide ideation in early adolescence are discussed.

This study examined the roles of social competence and social support as potential mediators of the association between psychopathology and functional outcomes in a middle school sample (n = 521). Participants were stratified into four psychopathology risk groups (depression only, conduct problems only, comorbid depression and conduct problems, low symptoms) based on screening during early 6th grade. Functional outcomes were 6th grade point average (GPA) and parent rating of global adaptive functioning in their 7th grade student. Low levels of social competence were found to mediate the association between symptoms and both lower grades and global functioning for adolescents with depressive symptoms alone and with comorbid symptoms, but not for those with conduct problems alone. Lack of social support mediated the association between psychiatric symptoms and lower grades for adolescents with depression alone and comorbid symptoms, but not for those with conduct problems alone. These findings suggest that intervention to improve social competence and social support may enhance functional outcomes, especially for youth with depressive symptoms or comorbid depressive and conduct symptoms. (Contains 5 tables.)

Background: School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral. Methods: Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost. Results: Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%. Conclusion: Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation. (Contains 1 figure and 5 tables.)

Background: Depression is prevalent among children and adolescents and often goes untreated with adverse effects on academic success and healthy development. Depression screening can facilitate early identification and timely referral to prevention and treatment programs. Conducting school-based emotional health screening, however, raises the controversial issue of how to obtain informed parental permission. Methods: During implementation of a depression screening program in an urban school district in the Pacific Northwest, the district's parental permission protocol changed from passive (information provided to parents via a school mailer with parents having the option to actively decline their child's participation) to active (information provided to parents via a school mailer requiring the written permission of the parents for their child's participation). This change provided an opportunity to examine differences in participation under these 2 conditions. Results: A total of 1533 students were enrolled in this program across both years. Compared to conditions of passive permission, participation was dramatically reduced when children were required to have written parental permission, dropping from 85% to 66% of eligible children. Furthermore, under conditions of active parental permission, participation decreased differentially among student subgroups with increased risk for depression. Conclusions: Successful implementation of school-based emotional health screening programs requires careful consideration of how to inform and obtain permission from parents. (Contains 2 tables and 1 figure.)

Self-inflicted injury in adolescence indicates significant emotional and psychological suffering. Although data on the etiology of self-injury are limited, current theories suggest that the emotional lability observed among self-injuring adolescents results from complex interactions between individual biological vulnerabilities and environmental risk. For example, deficiencies in serotonergic functioning, in conjunction with certain family interaction patterns, may contribute to the development of emotional lability and risk for self-injury. The authors explored the relation between peripheral serotonin levels and mother-child interaction patterns among typical (n = 21) and self-injuring (n = 20) adolescents. Findings revealed higher levels of negative affect and lower levels of both positive affect and cohesiveness among families of self-injuring participants. Peripheral serotonin was also correlated with the expression of positive affect within dyads. Furthermore, adolescents' serotonin levels interacted with negativity and conflict within dyads to explain 64% of the variance in self-injury. These findings underscore the importance of considering both biological and environmental risk factors in understanding and treating self-injuring adolescents.

In this study we examined cognitive features that have been posited to contribute to depressive vulnerability in adolescents. Using a longitudinal sample of 331 young adolescents followed from 6th to 7th grade, cross-lagged structural equation analyses were conducted. Controlling for baseline levels of depressive, conduct, and anxiety symptoms, low self-worth was associated with a vulnerability to both depressive symptoms and conduct problems, whereas rejection sensitivity was uniquely predictive of increases in anxiety. In support of cognitive "scar" models, baseline depressive and conduct problems were both predictive of a more negative attributional style. Depressive symptoms also predicted more rejection sensitivity, whereas conduct problems predicted lower self-esteem.

Objective: Adolescents constitute a high-risk population for traumatic physical injury, yet few longitudinal investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms over time in representative samples. Method: Between July 2002 and August 2003,108 randomly selected injured adolescent patients ages 12 to 18 and their parents were interviewed at baseline and again 2, 5, and 12 months postinjury. Initially, participants were screened for PTSD symptoms with the PTSD Reaction Index (PTSD-RI) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale, as well as preinjury trauma. Random-coefficient regression was used to assess the association between baseline clinical, injury, and demographic characteristics and the development and maintenance of PTSD symptoms longitudinally. Results: Between 19% and 32% of adolescents screened positive for PTSD (i.e., had PTSD-RI scores of [greater than or equal to]38) during the course of the 12 months after the injury. Higher initial adolescent PTSD and depressive symptoms, higher emergency department heart rate, greater objective event severity, and greater parental preinjury trauma were significant independent predictors of higher adolescent PTSD symptoms. Conclusions: For a substantive minority of hospitalized adolescents, high PTSD symptom levels persist during the 12 months after injury. Clinical characteristics readily identifiable after the acute injury predict the development of PTSD symptoms over time. Real-world clinical trials that test screening and intervention procedures for representative samples of at-risk youths are warranted. (Contains 1 figure and 3 tables.)

This article describes the implementation of the Developmental Pathways Screening Program (DPSP) and an evaluation of program feasibility, acceptability, and yield. Using the Mood and Feelings Questionnaire (MFQ) and externalizing questions from the Youth Self Report (YSR; Achenbach, 2001), universal classroom-based emotional health screening was implemented with students as they began middle school. Of all sixth graders enrolled in four participating Seattle schools, 861 (83%) were screened. Students who screened positive for emotional distress (15% of students screened) received onsite structured clinical evaluations with children's mental health professionals. Seventy-one percent of students who were evaluated were found to be experiencing significant emotional distress, with 59% warranting referral to academic tutoring, school counselor, and/or community mental health services. Successful implementation of in-class screening was facilitated by strong collaboration between DPSP and school staff. Limitations of emotional health screening and the DPSP are discussed, and future steps are outlined.

Current conceptualizations of oppositional defiant disorder (ODD) place the symptoms of this disorder within three separate but related dimensions (i.e., angry/irritable mood, argumentative/defiant behavior, vindictiveness). Variable-centered models of these dimensions have yielded discrepant findings, limiting their clinical utility. The current study utilized person-centered latent class analysis based on self and parent report of ODD symptomatology from a community-based cohort study of 521 adolescents. We tested for sex, race, and age differences in the identified classes and investigated their ability to predict later symptoms of depression and conduct disorder (CD). Diagnostic information regarding ODD, depression, and CD were collected annually from adolescents (grades 6–9; 51.9% male; 48.7% White, 28.2% Black, 18.5% Asian) and a parent. Results provided evidence for three classes of ODD (high, medium, and low endorsement of symptoms), which demonstrated important developmental differences across time. Based on self-report, Black adolescents were more likely to be in the high and medium classes, while according to parent report, White adolescents were more likely to be in the high and medium classes. Membership in the high and medium classes predicted later increases in symptoms of depression and CD, with the high class showing the greatest risk for later psychopathology. [ABSTRACT FROM AUTHOR]

Objective: This study examined childhood behavior problems at ages 10 and 11 years as predictors of young adult depression, social phobia, and violence at age 21 years. Method: Data were collected as part of the Seattle Social Development Project, a longitudinal study of 808 elementary school students from high-crime neighborhoods of Seattle. Reports of childhood behavior problems were obtained from parents and children in fall 1985 and from teachers in spring 1986. Follow-up reports of violence and DSM-III-R depression and social phobia were collected from 765 respondents using standard survey items and the Diagnostic Interview Schedule in 1996. Results: The past-year prevalences of depressive episode and social phobia were 20% and 17%, respectively. Twenty-one percent of the respondents reported two or more violent acts in the past year at age 21 years. Several available measures of childhood behavior problems as reported by parents, teachers, and children predicted violence (e.g., conduct problems, oppositional defiance); the strongest positive predictor of young adult violence was self-reported conduct problems, whereas self-reported shyness inhibited later violence. Relatively few child behavioral problems predicted social phobia (e.g., shyness). Results showed that children who reported higher, relative to lower, levels of conduct problems were nearly four times more likely to experience a depressive episode in early adulthood. Conclusions: Findings suggest the potential value of intervening to reduce childhood conduct problems as a prevention strategy for not only violence but also depression.

Adolescent depression is a serious and debilitating disorder associated with lifelong negative outcomes, including heightened risk for recurrence into adulthood, psychiatric comorbidities, and suicide. Among evidence-based treatments for adolescents, psychotherapies for depression have the smallest effect sizes of all psychiatric conditions studied. Advancing care for depression in adolescents is complex due to the heterogeneity in etiology and co-occurring difficulties among youth presenting with depression symptoms. This and a companion paper (Lewandowski et al., 2022) draw on a recent multisite collaboration that focused on implementing depression treatment for adolescents within clinical and research contexts. Specifically, this paper will review our work adapting behavioral activation (BA) as a principle-based framework to improve effectiveness and efficiency of depression treatment used within clinical and research settings in academic medical centers. Piloted adaptations include the use of BA principles to address idiographic drivers of depression and in-session BA "exposures" to illustrate BA principles. Case vignettes illustrate these adaptations of BA to address adolescent depression in the context of co-occurring difficulties. [ABSTRACT FROM AUTHOR]

This paper describes the implementation of Behavioral Activation (BA) as the core psychotherapy treatment within a broader clinician-led effort to establish a care pathway for adolescent depression in an academic medical center that served public and private hospital systems. This quality improvement effort required a standardized yet flexible approach to psychotherapy to be used by clinicians with a range of experience and training backgrounds while serving diverse clinical populations in child psychiatry and pediatric clinics. This paper highlights implementation of BA in treating adolescent depression across these varying systems. In particular, the paper emphasizes the application of BA as a principle-driven, treatment that enables flexibility across settings while remaining rooted in scientific evidence. The paper also reviews lessons learned from this effort that may support efforts to implement BA in other clinical settings and systems. [ABSTRACT FROM AUTHOR]

Background Few studies on the occurrence of depression in pediatric patients with chronic kidney disease (CKD) have been conducted and none have identified associated clinical and demographic factors. Methods This was a cross-sectional study in which we administered the Child Depression Inventory-2 (CDI-2) to 44 patients aged 9-18 years with CKD stages III-V. Criteria for depression were CDI-2 scores of >65 or an established diagnosis of depression recorded in the medical chart. Relative risks (RR) and 95 % confidence intervals (CI) were calculated to determine associations between patient characteristics and depression status. Results Of the 44 patients enrolled in the study, 13 (30 %) met our criteria for depression, representing 18 % of patients aged Conclusions Our results indicate that depression is common in children with CKD, particularly for those with longstanding renal disease and at CKD stage III. Keywords Child depression inventory * Adolescents * Children * Dialysis * Transplant * Mental health, Introduction As medical advances allow for the increased life expectancies of children with chronic kidney disease (CKD), the psychological complications of their disease become increasingly important. Children with CKD suffer [...]